Hospital in the home for hip fracture patients : a feasibility study

Setting: The Orthopaedic Department is rolling out a new pathway within its hip fracture care pathway. It is adding a hospital in the home (HITH) component for patients who fit the criteria for eligibility. As per the NSW Health HITH Guidelines, patients involved in HITH programs must consent to the intervention. The Intervention is NOT a research intervention; it is a clinical intervention; if patients who are eligible decline the intervention, they receive usual care. The research component involves following hip fracture patients regardless of whether they accept or decline the program. Patients do not enroll in the study per se; monitoring of patients to at least 6-weeks post-admission is routine at our facility, including the review of such data by researchers. The program will be reviewed over a 5-6-month period, resources permitting. The final patients to be reviewed in the program will be admitted before 24th December 2024, thus their 6-week follow-up will be in January 2025. HITH-accepted Group: A hospital in the home (HITH) program is being added to the usual hip fracture care pathway as an alternative model of care for appropriate patients.. This group includes people who meet the eligibility criteria for a HITH program and who consent to participate in the HITH program after discussion with the treating team. Patients and carers are given information about the program, to help them decide whether a HITH program is suitable for them. Once the person meets the criteria for transfer to the HITH program (this is expected to occur at a minimum 3-4 days after surgery), the person/participant will be transferred to their home. As per the clinical pathway for HITH, HITH staff (comprising a multidisciplinary team, MDT) will review the patient each day (in person and/or over the telephone as appropriate) and provide care that is comparable to that which would have been provided had the person stayed in a physical hospital ward bed. The MDT comprises a full-time physiotherapist, and part-time nurse and occupational therapist. Medical input is provided by the treating team, but reviews by medical staff occur either virtually or via a hospital-based clinic if required. After-hours, patients/carers are requested to contact the hospital, their local doctor or an ambulance depending on the urgency of the problem. The participant will be discharged from the program according to the same criteria used to discharge a patient from usual care (physical hospital ward). Researchers will review the medical record to extract length of stay in the HITH program, number of HITH visits by staff, complications and any additional healthcare resource use. .